The problem with this study is that the analysis is based upon intention to treat. Only 42% of those who were randomized to get a colonoscopy actually got one. The cancer incidence was 18% lower among all people who were invited to get a colonoscopy. If we assume rate among people who were invited to get a colonoscopy but did not go through with it is the same as the rate of people who did not get a colonoscopy then the cancer rate would be more like -2/3 among those who got a colonoscopy.
Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
91–100 of 205 posts
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#92Earlier quoted context omitted.
"Death rate" != "Cancer Rate." Cancer is much more treatable, these days. I had a friend that just underwent seven months of chemo for colorectal cancer. Looks like he'll be fine, but it was Stage IV, when it was discovered. Had a couple of surgeries, and radiation. The chemo was the worst, though. He channeled Uncle Fester, and this was a fairly robust, somewhat overweight chap. So he would not go in the "death" col…
Yeah, it's pretty complicated. I'm not that surprised death rates were similar. Colonoscopies will catch pre-cancerous masses like polyps, so I can see the cancer rate being lower. But if diagnosed with cancer, treatments are quite good for colorectal cancer, so you may not see that much of a difference in death rate on a 10 year horizon.
Well then the title is indeed misleading. It's not the colonoscopy that's failing to reduce cancer death rates, treatments are. Indeed the title should have been: with colon cancer deaths unchanged, screening and pre-malignant treatments are ever more important.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#93This is about colonoscopy screening . If you give a fecal sample and it comes up as suspicious, the next step will be a colonoscopy anyway. A colonoscopy is quite unpleasant; you starve for a day, and take an enema. They may sedate you before the procedure. If they don't, then the procedure is quite uncomfortable; not exactly painful, but unpleasant. Incidentally, if they find and remove a polyp, they will plant a ta…
> you starve for a day fast for a day, starvation is another thing and takes weeks to set in for the average westerner
"Hungry is after three days" as I once heard it ...
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#94Vinay Prasad, MD (Heme/Onc) gives a very good rundown on why this trial is so important. He also points out why having accurate data for screening recommendations is so crucial. USPTF has been making recommendations recently without data to back up them up and get appropriately taken to task for that. [1] https://m.youtube.com/watch?v=SMRS4-ng8T0
Beware Vinay Prasad:
https://www.respectfulinsolence.com/2022/07/27/john-ioannidi...
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#95This is about colonoscopy screening . If you give a fecal sample and it comes up as suspicious, the next step will be a colonoscopy anyway. A colonoscopy is quite unpleasant; you starve for a day, and take an enema. They may sedate you before the procedure. If they don't, then the procedure is quite uncomfortable; not exactly painful, but unpleasant. Incidentally, if they find and remove a polyp, they will plant a ta…
They can be very painful, in my experience. I would not opt for one without sedation again.
Thanks for these corrections. Yes, I should have said "fast". And indeed for my recent colonoscopy, I was given laxative, not an enema, it's a sachet of powder that you dissolve in a litre of water; you then have to gulp that down as well as drinking lots of water. Years ago I had a sigmoidoscopy, and then they did give me an enema. That's the only time I've had an enema, and I didn't know what to expect. It was very rapid, and rather dramatic.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#96Earlier quoted context omitted.
The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening…
I’m so confused though, because based on my reading of it, it seems like the prostate screening thing where yes it might find cancer but no it won’t prevent deaths, so it might be better to just not know/do invasive procedures and treatment for it. Is that the wrong conclusion to reach from the data?
You could think of screening as a bet on anti-cancer drugs getting better over the next N years.
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#97Earlier quoted context omitted.
The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening…
> The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. That is exactly what I thought it was saying at a glance. If I skimmed the headline and moved on, instead of digging in, it might have contributed to an unconscious bias against the procedure.
Uh... I think it is what it's saying though? I mean, you should probably still get a colonoscopy if recommended by your doctor which it probably will be right now... but the effects of this study may be to change those recommendations down the line, that is what it suggests. (I think it's not the first, but I'm not sure).
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#98Earlier quoted context omitted.
There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard”…
The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should. The study answers a question pertaining public health policy (should we invite everyone in some age group for a colonoscopy?). It does not answer any individual health/treatment/screening…
> The problem with the title is that it might lead individuals to believe they shouldn't bother with getting a colonoscopy. You can't conclude that from this study at all. If your doctor recommends you to get one, you probably should.
The problem with your doctor's recommendation is that doctors recommend colonoscopy based on age, not whether you have any factors that might indicate colon cancer. I have no cancer of any kind anywhere in my family tree and they are always on me to get one.
From the article, a doctor who still believes in colonoscopy for everyone: “The first message is that screening saves lives [Ed: against this study's data] and prevents cancer. If we could have a chance to start everyone at age 45, I’d like that."
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#99Earlier quoted context omitted.
There is nothing wrong with the title. The study failed to find a reduction in death rate despite lowering the incidence of cancer, and that is the center of the piece. It goes into detail of why this is surprising. The study authors were interviewed and agreed. The reporting actually adds a lot of context that you would never get from a link to a random study. Like, for example, how it is called the “gold standard”…
"Death rate" != "Cancer Rate." Cancer is much more treatable, these days. I had a friend that just underwent seven months of chemo for colorectal cancer. Looks like he'll be fine, but it was Stage IV, when it was discovered. Had a couple of surgeries, and radiation. The chemo was the worst, though. He channeled Uncle Fester, and this was a fairly robust, somewhat overweight chap. So he would not go in the "death" col…
I guess the question is if the scan makes a difference in intensity of treatment, if people who got a colonoscopy had fewer surgeries or fewer/less radiation. It doesn't say, I think? It's not at all obvious it would.
(In general, one would think people who got the colonoscopy got more treatment -- in this case despite having no lower a death rate -- but perhaps it does not include as much intense treatment).
Re: Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
#100Earlier quoted context omitted.
Yeah, it's pretty complicated. I'm not that surprised death rates were similar. Colonoscopies will catch pre-cancerous masses like polyps, so I can see the cancer rate being lower. But if diagnosed with cancer, treatments are quite good for colorectal cancer, so you may not see that much of a difference in death rate on a 10 year horizon.
Well then the title is indeed misleading. It's not the colonoscopy that's failing to reduce cancer death rates, treatments are. Indeed the title should have been: with colon cancer deaths unchanged, screening and pre-malignant treatments are ever more important.
This is nonsensical. Any number of things are failing to reduce cancer death rates, including professional football and jelly donuts. This study is about colonoscopies also failing to reduce cancer death rates.
Changing the title to Don't Worry About Colon Cancer Death Rates, Just Continue To Do What You're Told would not have been better or more accurate.